“What a fool! It proves nothing of the sort,” thought the Magistrate, stroking his cinnamon whiskers with excitement that bordered on ecstasy.
However, Dr Dunstaple had now adopted a less ranting and more scientific tone which the audience could not help but find impressive. Some of his oldest friends, who for years had been accustomed to seeing him, fat and genial, as the leading light of a pig-sticking expedition, were astonished to hear him now holding forth like a veritable Newton or Faraday and discussing the latest discoveries in medicine as fluently as if they were entries in the Bengal Club Cup or the Planters’ Handicap. One or two of his supporters turned to direct malicious glances at Dr McNab, who was still leaning calmly against the ledge and listening attentively to what his prosecutor had to say. Louise, too, had dried her tears. Her father was not doing too badly and perhaps, after all, he might be right about McNab.
“When you inhale the poison of cholera it kills or impairs the functions of the ganglionic nerves which line the air-cells of the lungs … hence, the vital chemistry of the lungs is suspended; neither caloric nor vital electricity is evolved … hence, the coldness which is so typical of cholera. The blood continues to be black and carbonated … the treacly aspect of the blood in cholera is well known … and in due course the heart becomes asphyxiated. This is the true and basic pathology of cholera. The disease is, however, attended by secondary symptoms, the well known purging and vomiting which, because they are so dramatic, have frequently been taken by the inept as indicating the primary seat of the infection … I need hardly add that this is the view held by Dr McNab.”
Once again, heads turned in McNab’s direction and the Magistrate’s sharp eyes were able to detect a number of veiled smiles and smothered chuckles. McNab was frowning now, poor man, and looking worried as well he might with Dr Dunstaple, transformed into Sir Isaac Newton, mounting such an impressive attack. But Dr Dunstaple had now moved on to the treatment.
“What must it consist of? We must think of restoring the animal heat which has been lost and we must consider means of counter-irritating the disease … Hence, a warm bath, perhaps, and a blister to the spine. To relieve the pains in the head we might order leeches to the temples. An accepted method of counter-irritation in cholera is with sinapisms applied to the epigastrium … or, if I must interpret these learned expressions for the benefit of my distinguished colleague, with mustard-plasters to the pit of the stomach …”
There was subdued laughter at this sally. But the Doctor held up his hand genially and added: “As for medicine, brandy to support the system and pills composed of calomel, half a grain, opium and capsicum, of each one-eighth of a grain, are considered usual. I could continue to talk about this disease indefinitely but to what purpose? I believe I have made my point. Now let Dr McNab justify his curious treatments, or lack of them, if he can.”
Dr McNab was silent for such a long time that even those of his supporters who had remained steadfast throughout Dr Dunstaple’s persuasive arguments and had not yet crossed his name from their emergency cards, began to fear that perhaps he had nothing to say. It surely could not be that McNab was confounded, utterly at a loss, for surely almost anyone could string a few medical terms together (enough to convince the survivors of Krishnapur if not the Royal College of Physicians) and save face. But still the silence continued. McNab’s head was lowered and he seemed to be pondering in a lugubrious sort of way. His lips even moved a little, as if he were giving himself a consultation. At length, with a sigh and in a conversational tone which did not match Dr Dunstaple’s oratory for effect, he observed: “Dr Dunstaple is quite wrong to suggest that there is an accepted treatment for cholera. The medical journals still present a variety of possible remedies, many of which sound most desperate and bizarre … missionaries report from China that they have been cured by having needles stuck into their bellies and arms, yet this is not thought too strange to mention … and almost every variety of chemical substance has been proposed at one time or another, all of which is a sure sign that our profession remains baffled by this disease.”
“Needles stuck in people’s bellies to cure cholera, whatever next!” the audience appeared to be thinking. And the Magistrate, watching like a stoat, could see by the alarm on their faces that they were assigning this treatment to Dr McNab for no other reason than that he had happened to mention it. Here, in a test-tube before his very eyes, ignorance and prejudice were breeding like infusoria.
“In the greater number of epidemic diseases,” McNab went on, “the morbid poison appears to enter the blood in some way, and after multiplying during a period of so-called incubation, it affects the whole system. Such is undoubtedly the case in smallpox, measles, scarlet fever and the various kinds of continued fever … but it must be remarked that in these diseases the illness always begins with general symptoms, such as headache, rigors, fever and lassitude … while particular symptoms only appear afterwards. Cholera, on the other hand, begins with an effusion of fluid into the alimentary canal, without any previous illness whatsoever. Indeed, after this fluid has begun to flow away as a copious diarrhoea the patient often feels so little indisposed that he cannot persuade himself that anything serious is the matter.”
“Irrelevant!” muttered Dr Dunstaple loudly but McNab paid no attention and continued calmly.
“The symptoms which follow this affection of the alimentary canal are exactly what one would expect. If you analyse the blood of someone with cholera you’ll find that the watery fluid effused into the stomach and bowels isn’t replaced by absorption. The experiments of Dr O’Shaughnessy and others during the cholera of 1831-2 show that the amount of water in the blood was very much diminished in proportion to the solid constituents, as also were the salts … Well, the basis of my treatment of cholera is quite simply to try to restore the fluid and salts which have been lost from the blood, by injecting solutions of carbonate of soda or phosphate of soda into the blood vessels. Does that sound unreasonable? I don’t believe so. At the same time I try to combat the morbid action by using antiseptic agents such as sulphur, hyposulphite of soda, creosote or camphor at the seat of the disease … that’s to say, in the alimentary canal …”
“How eminently full of reason!” thought the Magistrate. “It will be too much for them, the dolts!”
“It’s often been regretted by physicians that calomel and other medicines aren’t absorbed in cholera … but this regret is needless, in my opinion, as they don’t need to be absorbed. If calomel is given in cholera it should obviously not be in pills, as Dr Dunstaple suggests, but as a powder for the sake of better diffusion.”
To say that the audience had found Dr McNab’s discourse dull would not be entirely accurate; they had found it soothing, certainly, and perhaps monotonous. Many of those present had found it hard to pick up the thread of what he was saying and instead had thought with a shiver: “Needles driven into your belly! Good heavens!” But Dr McNab had at least one attentive listener and that was Dr Dunstaple.